Abdominal trauma

Question 1

Types of abd trauma

Answer 1

Injury below nipple line
1. Penetrating - gun shot, stab
2. Blunt

Question 2

Mx of gun shot wound to abd

Answer 2

Exploratory laparotomy

Question 3

Mx of stab wound abd

Answer 3

●Exploratory Laparotomy:
Viscera protruding
Peritonitis - sev pain, rigidity
Unconscious pt

●Other cases:
Rectus fascia checked
Not penetrated - no mx req
penetrated - FAST/CT abd/sx exploration

Question 4

Mx of blunt trauma abd

Answer 4

Internal organ injury: Sx evaluation (expl laparotomy)
Pain, guarding, rigidity, unstable

Question 5

FAST scan

Answer 5

Bedside inv in trauma pt - unstable - best - FAST
Focused Abdominal Sonography for trauma (for fluid)
1. Peri-hepatic
2. Peri-spleenic
3. Pelvic
4. Pericardium

Stable - best - CT

Question 6

Mcc of significant intra abdominal bleeding, mc associated fracture?

Answer 6

Splenic rupture
mc a/w lower ribs #

Question 7

Grades of splenic rupture

Answer 7

Grade
1 = SCH <10% SA, L <1cm
2 = SCH 10-50%, L 1-3 cm
3 = SCH >50%, L > 3cm
4 = >25% devascularisation, L segmental/hilar vessels
5 = Shattered spleen/ hilar injury with complete devascularisation

Grades 1-4 can be stable, mx is observation/repair
Grade 4 - splenic artery embolisation if unstable
Grade 5 - usually unstable, mx splenectomy

SCH - subcapsular hematoma
L - Laceration